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Management of fetal growth restriction

Fetal Medicine Research Unit, University of Bristol, St Michael’s Hospital, Bristol, UK

Correspondence to:
Correspondence to:
P Soothill
Fetal Medicine Research Unit, University of Bristol, St Michael’s Hospital, Southwell Street, Bristol BS2 8EG, UK;peter.soothill{at}bristol.ac.uk

ABSTRACT
Fetal growth restriction (FGR) is challenging because of the difficulties in reaching a definitive diagnosis of the cause and planning management. FGR is associated not only with a marked increased risk in perinatal mortality and morbidity but also with long-term outcome risks. Combinations of fetal biometry, amniotic fluid volume, heart rate patterns, arterial and venous Doppler, and biophysical variables allow a comprehensive fetal evaluation of FGR. However, no evidence supports that the use of cardiotocography or the biophysical profile improves perinatal outcome. Therefore, obstetricians aim to identify fetuses with early FGR so delivery can be planned according to gestational age and severity of the condition. The balance of risks and the need for the availability of services mean that the involvement of neonatologists in FGR management is vital. In this review, the focus is on the pathophysiology and management of FGR caused by placental diseases.

Abbreviations: BPP, biophysical profile; CTG, cardiotocography; FGR, fetal growth restriction; PET, pre-eclampsia; SGA, small for gestational age